Introduction/Background Covid-19 has resulted in significant number of elective surgeries being delayed or cancelled worldwide with an estimated 28 million patients being affected.1
Studies show that perioperative Covid-19 infection has a high perioperative mortality of 23·8%. (2) Complications increase with any additional treatment burden such as cytotoxic chemotherapy, radiotherapy or immunotherapy.3 In an effort to reduce treatment related morbidity and mortality during the Covid-19 pandemic, many elective anticancer treatments have been postponed or modified.4
Methodology We investigated the impact of the Covid-19 pandemic on gynaecological cancer surgery in an international prospective multi-centre study. Participating centres entered consecutive patient’s data into a customized electronic database for 12 weeks from the first COVID positive patient managed in their hospital between March and June 2020. Patients were eligible for enrollment if they were planned to undergo surgery during the study duration, regardless of COVID-19 status and whether they underwent surgery as recommended or not. Patients who did not undergo their planned surgery were followed up for 12 weeks to observe outcomes. Descriptive analysis of outcomes is presented.
4490/4472 (95%) patients received surgery; of these 17% (n=758) experienced change or adaptation of surgery. The main impact was on surgical timing; 11% ( n=483) experienced delay in surgery, 3% (n=119) a change in choice of operation, 10% (n=452) received surgery in alternative hospital.
Patients in this study had confirmed resolved COVID-19 prior to surgery in 0.95% (n=45) patients with an additional 0.34% (n=16) with probable resolved COVID-19 infection. A post-operative COVID-19 rate of 2.27% (n=25) and pulmonary complication rate of 1.8% (n=20) was found in the initial analysis of the Covidsurg cancer data, analysing outcomes for 1102 gynaecological cancer patients. The overall 30-day mortality rate in this cohort was 1.18% (n=13).5
Conclusion The largest multi-centre analysis of gynaecological cancer surgery during the Covid-19 pandemic has demonstrated significant adjustments of timing, indications and radicality of surgery in an effort to reduce COVID-19 related complications and has exposed constraints, even in high income countries. Nevertheless, perioperative pulmonary complications and death rates of COVID-19 affected operated women were overall low compared to data reported for other cancers. Failsafe systems are urgently needed to ensure continuity of high standard oncologic care to preserve cancer survival.
Covidsurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. BJS 107(11).
Covidsurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet. 2020 Jul 4;396(10243):27–38.
Giorgio Bogani N, Antonino Ditto, Sara Bosio, Claudia Brusadelli, Francesco Raspagliesi Cancer patients affected by COVID-19: Experience from Milan, Lombardy; Gynecologic Oncology; June 2020.
Olivia D Lara, Roisin E O’Cearbhaill, Maria J Smith; Megan E Sutter, Anne Knisely, Jennifer McEachron, Lisa R Gabor, Justin Jee, Julia E Fehniger, Yi-Chun Lee, Sara S Isani, Jason D Wright, and Bhavana Pothuri. COVID-19 Outcomes of patients with gynecologic Cancer in New York City.ACS journals.
James C Glasbey, Aneel Bhangu, and on behalf of the COVIDSurg Collaborative. Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study. Journal of Clinical Oncology 0 0:0.
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